GENDER STUDIES/PSVCHOLOGY/MEQIC »il "This is a brave book. Kessier says things that need to he said. ■■:■! id- ■■»>■' concisely, and with respect for the people whose lives are mo«. -.i'wii-ii by she confronts. A must read for anyone concerned with inten-» —sic- "..... author of Gender Blending: Confronting the Limits of Duality and FTM: F?twl • K't«c ihmiw "While the physician's response to an infant with amhigU' •■:- i'i-rüiriia produce categories like the 'successful vagina' and the 'gc-'d i-nnn/h \-takes her cues from intersexuals themselves, This book if» a brti':>(t(> ■"«' l(1" for the reevaluation of gender variability." —JUDITH HäIBERSTRk ■■ •h-n-i /-■«.. "Fascinating in what it tells us not only about situations trs «dieli -*■* .■>•■ uncertain but about the astonishingly weak empirical founds1»"!-, «m which t orthodoxies of binary sex and gender are built. A must for amrnr ihiiti^ic-í : widely accepted social beliefs and scientific explanations gn.'-'-t!f ;md m\ other.11 —RUTH HUBBARD, author of The Politics of Hitmen's Biolog* -»sisl Kiphidm? ■'' C ■ £ £: 9 E c = 2- £ 3 š šr s o I í £ S = "B S. » É 3 t C L ? * 3 o n m en I 's - medical the ways tree each fit-ne Myth From the moment intersexuality—the condition of having- p:iv-ii«l g.-nd-(genitals, gonads, or chromosomes) that are neither clearly fetn-ih" iii.r in.ili-and diagnosed, social institutions are mobilized in order to i:;.ii!i!->::: Hie i*»-objective sexual categories. Infants' bodies are altered, and i's'- "niTiliiviitii-""normal." As Kessler argues, the way the medical and psychcl'ii'n-.d profe—r intersexuality is guided by our culture's beliefs about gender .nid peniiiiK mii the needs of the child. Interviews with pediatric surgeons and endocrinologists as »Ml .i«, p.iiciir-* i ■ children and adults who were treated for this condition in > hiMhimd Im" propose several new approaches for physicians in dealing *iih parent- ,w< Beyond the medical sphere, the author also evaluates a polnica! \:niuii.ir'i gaining acceptance by physicians and society at large of an inhTM-vd idriiiny Lessons from the Intersexed explores the possibilities and iiupii.-iiiifiiľ» of a commitment to two "natural" genders. It addresses gender íIi-.mIiÍIí/íiiioíi i!-from intersexuality and compels a rethinking of the meaning 'if grndrr. ;n sexuality. markers .u sped ed -eemingly is made .. manage r (han by ntersexrd Messier to children, intent on spending ;'S arising nah, and Suzanne J. Kessler is professor of psychology at Purchase ('ulli-pf-. Smn I : iversity of New York. She is co-author of Oenden An Etfmotnvtlwdatagitnf hymn it h Cover illustration: 'Visit to a Family Doctor1 by Norman Roekweii. Printedby permission of the Norman Rockwell Family Trust, © 194? the Norma' I! kwil !-niiul> i i ISBN o-ai35-55:i;j-b " lii 9 0000 Rutgers University Press II 111 III! Will III'II 780813"5Z5303 Cß O Jri Cf) 15 S5 O X ^m 31 THE SLZ M ? o I 17 U 1 Introduction Alex A. was born in 1971. He called me to talk about what he labeled his "sexual differentiation disorder" and related his story: Alex was given a female gender assignment at birth, despite having labial-scrotum fusion. By age one or two Alex's mother noticed that his phallus was enlarged, and by the time he could speak, he called it "my penis." At puberty his voice deepened, and he began to be called "he-man" by other kids. He did not develop breasts, but by age thirteen, was menstruating irregularly from his phallus. A rural doctor put him on estrogen, and he developed small breasts but considerable axillary body hair. In his late teens Alex was sent to an endocrinologist who asked whether he had ever taken hormones. At that point, Alex did not even know what hormones were. The endocrinologist said: "I think you should change to a male" and gave him a prescription for testosterone, but Alex never filled it. He recalls, "We were very religious people. We [mother and I] didn't know what was going on." Alex's mother was encouraging him to "try and grow breasts." By age twenty-four his breasts started to enlarge. Recently, he saw another endocrinologist who said: "We can make you a girl" and bolstered this suggestion with the argument, "You know, women can even be managers now." Alex was told that his clitoris can be reduced and that an ultrasound revealed a uterus. In spite of the doctor's recommendation, Alex does not want to go this route. He is confused because he has always thought doctors were gods. He feels like a male and has no idea what his diagnosis is. Alex B. was born in 1963. At birth Alex was diagnosed with the condition "mixed gonadal dysgenesis" and was given a male gender assignment. Although regarded as a boy, the child was never 1 Lessons from the Intersexed really accepted as one. Everyone in the small town knew about Alex's genital abnormality. Now an adult woman, Alex remembers that her mother regularly examined her genitals and told her that "something like this simply was not acceptable." Yet, she remembers beingj^ntent with her body. She was hospitalized at age four for reasons she still does not know. Her parents said that it was a decision by some physician they had never consulted before. Her mother had her examined at a nearby hospital at age twelve because she was not experiencing puberty. Alex had hoped for breast development and sometimes tried to pass as a female, but her parents would correct other people's view. She was given testosterone shots for one and a half years. No one explained to her what the treatment was supposedly good for, and Alex was told she should not speak of it. Treatments were stopped because they did not achieve what was desired: growth of phallic tissue. But her voice did change, and she developed facial hair and involuntary clitoral erections, all of which enormously bothered her. At age twenty Alex left her hometown to get estrogen treatments and genital surgery. The first surgeon she went to said Alex did not have enough penile and scrotal skin to model a complete vagina and vulva. (Alex wanted to retain a functioning clitoris and put special emphasis on acceptable labia.) Her assessment is that he produced "at best a halfway aesthetically and functionally acceptable result." Although she considers the surgery as having been necessary, since she doubts whether she would have survived emotionally without it, she recognizes that she undertook it as an extreme reaction to previously extreme treatment that had been administered against her will. One year later Alex had surgery again, urged by a physician who wanted to repair the scar tissue. Without consulting her, he tried to elongate what he felt was her too short vagina. The scar tissue rebuilt itself, and the few extra centimeters were lost again. Alex was offered a third surgery to correct these problems but turned down the offer, as well as an offer for breast augmentation. After a long period of viewing herself as "asexual," Alex began having sexual relationships with female partners. Although she had considered reestablishing a relationship with her parents, she has been unable to come to terms with their dishonesty and has completely broken off contact with them and others from her hometown. Introduction 3 Alex C. was born in 1960. Alex's mother went into labor too quickly to get to a hospital, so the baby was born at home in a large city. Relatives recall that her genitals were ambiguous. Her mother remembers that the doctor said she was "probably a girl." __... Hergrandnxo-thexxemembers that he said she was "probably a boy." Because of the bad weather that winter, Alex was home with her parents for a month before being seen by another physician. She was brought to the hospital due to her failing health and was diagnosed as having congenital adrenal hyperplasia (CAH). I asked her, "Were you raised as a boy that first month?" She says that no one will discuss that period with her. Alex and I agree that her current name would have been appropriate for either a male or a female. Alex was treated by physicians continuously throughout her childhood. Blood was drawn repeatedly and her genitals were scrutinized. She claims that the endocrinologist and others at the hospital were conservative about surgery, possibly due to some bad experiences they had had. In addition, they were waiting for Alex's puberty to see whether her body would virilize further. Alex recalls that, starting around age eight, she began getting pressured by her mother {who was being pressured by the physicians) to accept the idea of genital surgery. The argument was: Don't you want to be normal? Get married? Have babies? She remembers her answer as always being, "No." She held off until age fourteen, when both she and her mother capitulated. (By that time her father had left and her mother had remarried.) Alex was given no psychological preparation and remembers having temper tantrums in the hospital before surgery. She awoke from the surgery experiencing incredible pain. The surgery was justified on the grounds that creating a vagina would eventually allow her to give birth. She remembers no mention of separating her scrotum to create labia or of reducing her clitoris. Her clitoris had been about three inches long and would have grown, according to her estimation, to be at the most five inches. In spite of the surgery to create a vagina, Alex refused all physician recommendations to dilate her vagina and threw the dilators in the wastebasket. Consequently, although her vagina is of a normal length, the width has never been increased. She can barely accommodate a junior tampon. Interestingly, although her parents made her undergo the surgery, they in no way pressured her to Lessons from the Intersexed stretch her vagina. Her mother's attitude was that now that Alex had one, she could make the decision when and if to increase its size. After Alex's first painful intercourse, she asked a physician if that was normal. Although she was assured it was not, she was not motivated to do anything to increase her vaginal capacity. Jjhfc. has always found intercourse painful and unsatisfactory and identifies herself as a lesbian. During sex she surfers intermittent genital pain, probably due to scar tissue and adhesions, but she is orgasmic. Alex says that her presurgical genitals were not a problem for her or her parents. Like most CAH girls, the family was more concerned about her state of health. Her situation differs from most other CAH girls [especially children today) in that she had no surgery until puberty. She developed strategies to avoid being seen in the locker room (such as changing before the others did), but she does not recall this as a particularly big deal. Although her urethra did not run through her clitoris, but rather underneath it [much like hypospadias), she used to stand to urinate. Unlike many other intersexed adults, Alex feels some sympathy for her mother's predicament and believes that she was as much a victim of the medical profession as was Alex. She is sure that her mother has a great deal of anger toward the physicians who never told her that her daughter's clitoris was being removed and that she would be sexually dysfunctional. At present, mother and daughter do not discuss the surgery, and Alex believes that her mother has "blocked it out." Intrigued with Intersexuality Who is each Alex "really"? Female or male? We tend to think that genitals, gonads, and secondary gender characteristics have some objective status and ought to be describable and describably female or male. Psychologists treat gender identity as objective. But how people categorized each Alex, as well as how the Alex's categorize themselves, seems rather elusive. Gender, that supposedly objective thing, is highly complex. Twenty years ago, Wendy McKenna and I analyzed (among other things) the exceptional case of transsexualism in order to demonstrate how gender is socially constructed in all cases.1 At that time, transsexualism was discussed only by transsexuals, and social constructionism was an "alternative" viewpoint. Today, Introduction 5 transsexualism is the subject of many fine analyses,2 and social constructionism is a mainstream theoretical perspective, grounding much of the work in Gender Studies and Queer Studies within which there is a particular interest in people who violate catego- ■ «ajan8^.T!ra.tajftSr*v.i.igliiaT> .as, nnintpH Ant maintains a rliphAtnmni.ifi.gen- _ n*""' *■*■**--------------------------------1 — t-----------------------------------------------------------------------------------------------o— der system. Other "transgressions," though, especially intersexuality and especially now, call the whole system into question. Gender theorists are intrigued by intersexuality (often referred to as "hermaphroditism"), an idea symbolizing complexity and fluidity.3 Television talk shows parade the real people who are living in intersexed bodies for the entertainment of an audience that is motivated like any old-fashioned side show crowd to gawk at the bizarre. Unlike a real sideshow, though, the remarkable genitals are not on view, and the audience is titillated only by the idea of intersex. Producers and consumers of pornography are intrigued by intersex genitals, it being almost incidental that they are connected to people and are usually the result of good special effects and not of actual body parts. The viewer can think: Look at how many different sexual acts can take place at the same time! I can watch "homosexual acts" without my heterosexuality being called into question (or vice versa) because the gender of those people on the screen is (in some sense) both or neither. The theory and practice of gender reflects a completely different set of concerns for some adult intersexuals. Because they resent the shame they experienced due to the secrecy surrounding their condition and the surgeries that were performed on them as infants, they started a political movement to change medical management and to halt infant surgeries. Intersex, for them, is an identity, even if the original mark has been surgically eliminated. All of these interests contrast with how the medical profession conceptualizes intersexuality—as a correctable birth defect. The meaning of the genital ambiguity for endocrinologists is limited to its marking of a more serious underlying medical disorder, much like a fever indicates infection. For the surgeon, the ambiguity signals an opportunity to fashion the inappropriate into the appropriate. Once the intersex marker has been corrected, the intersexed person (as intersexed) fades into the culture. The meaning of the genital variation is deflected. Physicians claim this is what the parents want. Parents are almost never heard from, but when they are, theirs is yet another perspective on this issue. What can be learned from examining all these perspectives? 6 Lessons from the Intersexed That, in essence, is the subject of this book, but before I describe its content in more detail, í will discuss yet another "case." Virtually all academic writing on sex and gender refers to a case first described by sexologist John Money in 1972. An infant boy's penis was ablated during routine surgery to free up his_cnn^. stricted foreskin. The physicians, believing that he could not develop a normal male gender identity without a penis, reassigned the boy to the female gender and performed surgery to create female genitals. The case was particularly interesting because the infant was an identical twin. This "experiment in nature" was used to test the gender socialization hypothesis. Would identical twins, one raised male and the other raised female, develop different gender identities and gender roles? Would biology (specifically prenatal hormones) be overridden by socialization? Money's initial report was very clear.4 Socialization ruled. The child was described as a typical little girl who could not be more different from her twin brother. The case was cited as proof of the plasticity of gender and appeared to have struck a mighty blow to biological determinism. When Money's theory was first introduced, it impressed people in the field of psychology as very radical. Gender was not only a social construction in theory, it could literally be constructed through human intervention. The surgeons would do their part in creating the necessary genitals, and the parents would do their part by creating the appropriate social environment, one in which the child was referred to with the relevant pronoun. Gender identity and gender role would then fall into place. Subsequent data about the twin forces us to reconsider Money's assertion. Sex researcher Milton Diamond located this twin, who Money claimed had been lost to follow-up, and reported that the child never accepted the female gender label, never acted like a "normal" girl, and at the age of fourteen requested hormones and surgery to convert him back to the male gender.5 Surgery and hormone treatment were provided, and Joan became John. Diamond and his colleague Sigmundson concluded that the prenatal androgen that the twin had been exposed to "overrode" the socialization, proving that you cannot make a girl out of a boy or vice versa.6 Introduction 7 inconsistent gender messages from the parents), the failure of reassignment in this particular case is not in question.7 Unlike the media, my interest in this case is not whether it supports a biological or social theory of gender development but _\^y^ender-tlieoristq (including McKenna and mys&lf} were so eager to embrace Money's theory of gender plasticity.8 Why, also, did it become the only theory taught to parents of intersexed infants— those born with neither clearly female nor clearly male genitals, gonads, or chromosomes? For whatever reason, gender researchers were blinded to a number of unexamined and deeply conservative assumptions embedded in Money's argument: 1. Genitals are naturally dimorphic; there is nothing socially constructed about the two categories. 2. Those genitals that blur the dimorphism belonging to the occasional intersexed person can be and should be successfully altered by surgery. 3. Gender is necessarily dichotomous (even if socially constructed) because genitals are naturally dimorphic. 4. Dimorphic genitals are the essential markers of dichotomous gender. 5. Physicians and psychologists have legitimate authority to define the relationship between gender and genitals. Those of us who are social constructionists and have postulated the primacy of gender attribution or gender performance should have been more critical of Money's theory for putting so much emphasis on the genitals as evidence of gender.9 We should have asked a number of questions, among them, Why did the twin boy have to be a girl if he did not have a penis? In this book I will examine the five assumptions above and try to answer the following questions: 1. How dimorphic are genitals? 2. How successful are genital surgeries? 3. Is gender necessarily dichotomous; could it be socially constructed to be trichotomous—at least? 4. Must genitals be the essential marker of gender? 5. How does the medical profession use its authority to manage a particular version of gender? 8 Lessons from the Intersexed Meanings of Variability We can think about variations in two very different ways. The first way is to note that most measurements of a feature cluster around the mean, thus creating a norm. The conventional medical view of intersexuality is that knowing the norms_of jtřeature like phallic size, and knowing that most measurements cluster around the mean, validates the existence of underlying pathology when norms are not met. According to this view, genitals that vary from the norm mark a disorder (for example, an enzyme deficiency), and treatment involves correcting both the deficiency and the marker. A second way to think about variation is to see it as validating the continuum of the feature, thus providing proof that there are arbitrary categories and subjective markers of acceptability. This is the view of gender theorists like Morgan Holmes, an intersexed woman who writes about the social construction of intersexuality. She objects to the typical medical phrase "enlarged clitoris" because it assumes that all "normal" clitorises are virtually identical in size.10 I have been deliberately using the term "variability" rather than the medical referent "ambiguity." As we will see in the next chapter, something needs to be done about "ambiguity," but it is less obvious what [if anything) needs to be done about "variability. " Genital variability has a number of possible meanings. I will review these meanings here and consider throughout the remaining chapters which constituencies advance which meanings and how meanings gain authority. Genitals that vary from a narrowly defined standard could have any number of different meanings:11 1. Your genitals signify neither of the two traditional gender categories. We need to know what gender you are, therefore we must do further testing. This meaning implies medical diagnosis but not necessarily surgical intervention. 2. We know your gender, but your genitals signify the wrong gender category. We must operate to make them conform to the right gender. The "must" implies that surgery is a medical advancement. 3. We know your gender. Your genitals, although not within the normal range foryourgendernow,willbeinthefníiľ-o va/»«------*■*'-■ r Introduction 9 that needs to be addressed. We prescribe (nonsurgical) treatment (for example, medication for children with the salt-losing form of congenital adrenal hyperplasia). 5. Your genitals are inferior (less functional, ugly). We pity you and suggest you ......._J}M?jrnrrerti\/f>frn Woman, Boy a> Girl (Baltimore: The Johns Hopkins University Press, 1972). 5. Milton Diamond, "Sexual Identity, Monozygotic Twins Reared in Discordant Sex Roles and a BBC Follow-Up," Archives of Sexual Behavior 11, no. 2 (1982):181-1987. 6. Milton Diamond and Keith Sigmundson, " Sex Reassignment at Birth: Long-term Review and Clinical Applications," Archives of Pediatric and Adolescent Medicine 151 (May 1997):298-304. 7. Kenneth J. Zucker, "Commentary On Diamond's Prenatal Predisposition and the Clinical Management of Some Pediatric Conditions," Sex and Marital Treatment 22, no. 3 (1996):148-160. 8. In a 1973 collection of readings, the editor (who coauthored a paper with Money) introduces Money's chapter on femininity and masculinity with, "John Money should receive the acclaim in the study of sexism that Kinsey or Masters and Johnson have received in the study of sexuality." (Clarice Stasz Stoll, ed., Sexism: Scientific Debates [Reading, Mass.: Addison-Wesley Publishing Company, 1973], 13). For the media's recent reinterpretation, see: Natalie Angier, "Sexual Identity Not Pliable After All, Report Says," New York Times, 14 March 1997, pp. AlandA18. 9. In addition to Kessler and McKenna, see Holly Devor, Gender Blending: Confronting the Limits of Duality (Bloomington: Indiana University Press, 1989), and Judith Butler, Gender Trouble: Feminism and the Subversion of Identity (New York: Routledge, 1990). 10. Morgan Holmes, "Re-membering a Queer Body," Undercurrents (May 1994):11-14. 11. This discussion of genital meanings was originally presented at a plenary symposium titled "Genitals, Identity, and Gender" at The Society for the Scientific Study of Sexuality, San Francisco, November 1995, and later published in Suzanne J. Kessler, "Meanings of Genital Variability," Chrysalis: The Journal of Transgressive Gender Identities 2, no. 4 (fall/winter 1998):33-38. 133 134 Notes to Pages 9-12 12. A popularized version of Money and Ehrhardt's Man & Woman, Boy &) Girl is ]ohn Money and Patricia Tucker's Sexual Signatures: On Being a Man or a Woman (Boston: Little Brown and Co., 1975). With few exceptions (see Julia Epstein, "Either/Or—Neither/Both: Sexual Ambiguity and the Ideology of Gender/' Genders 7 jspring 1990]: 99-14-2; Deborah Fir.dlay, "Discovering Sex: Medical Science, Feminism, and Intersexuality," The Canadian Review of Sociology and Anthropology 32 [February 1995]: 25-52; and material written by self-identified intersexuals), the intersex literature is not analytic. 2 The Medical Construction of Gender 1. For historical reviews of the intersexed person in ancient Greece and Rome, see Leslie Fiedler, Freaks: Myths and Images of the Second Self (New York: Simon and Schuster, 1978); and Vern Bullough, Sexual Variance in Society and History (New York: John Wiley and Sons, 1976). For the Middle Ages and Renaissance, see Michel Foucault, History of Sexuality (New York: Pantheon Books, 1980). For the eighteenth and nineteenth centuries, see Michel Foucault, Herculine Barbin {New York: Pantheon Books, 1978); and Alice Domurat Dreger, Hermaphrodites and the Medical Invention of Sex (Cambridge: Harvard University Press, 1998). For the early twentieth century, see Havelock Ellis, Studies in the Psychology of Sex (New York: Random House, 1942). 2. Traditionally, the term "gender" has designated psychological, social, and cultural aspects of maleness and femaleness, and the term "sex" has specified the biological and presumably more objective components. Twenty years ago, Wendy McKenna and 1 introduced the argument that "gender" should be used exclusively to refer to anything related to the categories "female" and "male," replacing the term "sex," which would be restricted to reproductive and "love-making" activities (Kessler and McKenna). Our reasoning was (and still is) that this would emphasize the socially constructed, overlapping nature of all category distinctions, even the biological ones. We wrote about gender chromosomes and gender hormones even though, at the time, doing so seemed awkward. I continue this practice here, but I follow the convention of referring to people with mixed biological gender cues as "intersexed" or "intersexuals" rather than as "intergendered" or "intergenderals." The latter is more consistent with my position, but I want to reflect both medical and vernacular usage without using quotation marks each time. 3. See, for example: M. Bolkenius, R. Daum, and E. Heinrich, "Paediat-ric Surgical Principles in the Management of Children with Intersex," Progress in Pediatric Surgery 17 (1984):33-38; Kenneth I. Glassberg, "Gender Assignment in Newborn Male Pseudohermaphrodites," Urologie Clinics of North America 7 (June 1980):409-421; and Peter A. Lee et al., "Micropenis. I. Criteria, Etiologies and Classification," The Johns Hopkins Medical journal 146 (1980): 156-163. Notes to Pages 13-14 135 4. It is difficult to get accurate statistics on the frequency of intersexuality. Chromosomal abnormalities (like XOXX or XXXY) are registered, but those conditions do not always imply ambiguous genitals, and most cases of ambiguous genitals do not involve chromosomal abnormalities. None of the physicians interviewed would venture a pi.m.ss on rreoue-iic" rstes; but-áll claimed that intersexuality is rare. One physician suggested that the average obstetrician may see only two cases in twenty years. Another estimated that a specialist may see only one a year or possibly as many as five a year. A reporter who interviewed physicians at Johns Hopkins Medical Center wrote that they treat, at most, ten new patients a year (Melissa Hendricks, "Is It a Boy or a Girl?" Johns Hopkins Magazine 45, no. 5 [November 1993]: 10-16). The numbers are considerably greater if one adopts a broader definition of intersexuality to include all "sex chromosome" deviations and any genitals that do not look, according to the culturally informed view of the moment, "normal" enough. A urologist at a Mt. Sinai School of Medicine symposium on Pediatric Plastic and Reconstructive Surgery [New York City, 16 May 1996) claimed that one of every three hundred male births involves some kind of genital abnormality. A meticulous analysis of the medical literature from 1955 to 1997 led Anne Fausto-Sterling and her students to conclude that the frequency of intersexuality may be as high as 2 percent of live births, and that between .1 and .2 percent or newborns undergo some sort of genital surgery (Melanie Blackless et al., "How Sexually Dimorphic Are We?" unpublished manuscript, 1997). The Intersex Society of North America (ISNA) estimates that about five intersex surgeries are performed in the United States each day. 5. Although the interviews in this chapter were conducted more than ten years ago, interviews with physicians conducted in the mid- to late-1990s and interviews conducted with parents of intersexed children during that same time period (both reported on in later chapters) indicate that little has changed in the medical management of intersexuality. This lack of change is also evident in current medical management literature. See, for example, F.M.E. Slijper et al., "Neonates with Abnormal Genital Development Assigned the Female Sex: Parent Counseling," fournal of Sex Education and Therapy 20, no. 1 (1994):9-17; and M. Rohatgi, "Intersex Disorders: An Approach to Surgical Management," Indian fournal of Pediatrics 59 (1992):523-530. 6. Mariano Castro-Magana, Moris Angulo, and Platon J. Collipp, "Management of the Child with Ambiguous Genitalia," Medical Aspects of Human Sexuality 18, no. 4 (April 1984):172-188. 7. For example, infants whose intersexuality is caused by congenital adrenal hyperplasia can develop severe electrolyte disturbances unless the condition is controlled by cortisone treatments. Intersexed infants whose condition is caused by androgen insensitivity are in danger of eventual malignant degeneration of the testes unless these are removed. For a complete catalogue of clinical syndromes related to the intersexed condition, see Arye Lev-Ran, "Sex Reversal as Re- 168 Glossary phalloplasty: Any surgery on the penis. progestin virilization: A form of intersexuality caused by the mother's ingestion of synthetic androgens during pregnancy. The genitals oř the XX fetus become " masculinized Z''.....í stenosis: The narrowing of a canal or cavity (e.g., the vagina). true hermaphroditism: A form of intersexuality in which both ovarian and testicular tissue are present in either the same gonad or in opposite gonads. It is extremely rare. urinary meatus: The external opening of the urethra through which urine passes out of the body. vaginoplasty: Any plastic surgery on the vagina, especially to build, lengthen, or widen it. 5-alpha-reductase deficiency: A form of androgen-insensitivity caused by a genetic enzyme disorder that prevents testosterone from "masculinizing" the XY fetus's genitals before birth. The genitals "masculinize" at puberty. Bibliography Allen, Lawrence E., B. E. Hardy, and B. M. Churchill. "The Surgical Management of the Enlarged Clitoris." The Journal of Urology 128 (August 1982]:351-354. Alvarado, Donna. "Intersex." San fose Mercury News, 10 July 1994, p. 1. American Academy of Pediatrics. Position on Intersexuality News Release. Chrysalis: The Journal of Transgressive Gender Identities 1, no. 4 (fall 1997/winter 1998):1. Angler, Natalie. "New Debate Over Surgery on Genitals." New York Times, 13 May 1997, pp. ClandC6. --------. "Sexual Identity Not Pliable After All, Report Says." New York Times, 14 March 1997, pp. Al and A18. Anonymous. "Be Honest and Open with Sufferers." British Medical Jour-nal308 (April 1994):1041-1042. Anonymous. "Once a Dark Secret." British Medical Journal 308 (February 1994):542. Ask Isadora. "I Yam What I Yam." The Westchester County Weekly, 14 September 1995, p. 28. ---------. "Ongoing Conversations." The Westchester County Weekly, 21 December 1995, p. 28. Belman, A. B. "Editorial Comment Re: One-Stage Repair of Hypospadias: Is There No Simple Method Universally Applicable To All Types of Hypospadias?" The Journal of Urology 152 (October 1994}:1237. Beheshti, Mojtaba, Brian E. Hardy, Bernard M. Churchill, and Denis Daneman. "Gender Assignment in Male Pseudohermaphrodite Children." Urology 11, no. 6 (December 1983):604-607. Bigelow, Jim. The Joy of Uncircumcising'. Aptos, Calif.: Hourglass Book Publishing, 1, 995. Bing, Elizabeth, and Esselyn Rudikoff. "Divergent Ways of Parental Coping with Hermaphrodite Children." Medical Aspects of Human Sexuality (December 1970):73-88. Blackless, Melanie, Anthony Charuvastra, Amanda Derryck, Anne Fausto-Sterling, Karl Lauzanne, and Ellen Lee. "How Sexually Dimorphic Are We?" Unpublished manuscript, 1997. Bleier, Ruth. Science and Gender: A Critique of Biology and Its Theories on Women. New York: Pergamon Press, 1984. Blum, Lucille Hollander. "Darkness in an Enlightened Era: Women's Drawings of their Sexual Organs." Psychological Reports 42 (1978):867-873. Bolin, Anne. "Transcending and Transgendering: Male-to-Female Transsexuals, Dichotomy and Diversity." In Third Sex, Third Gender: 169 170 Bibliography Beyond Sexual Dimorphism in Culture and History, edited by Gilbert Herdt, 447-485. New York: Zone, 1994. Bolkenius, M., R. Daum, and E. Heinrich. "Paediatric Surgical Principles in the Management of Children with Intersex." Progress in Pediatric Surgery 17 (1984):33-38. Bradbur1' E. T. S.P.T. Ká" C. Ti°he andT. Hev/ison. "Dc'ision-mskiii"b**- Parents and Children in Paediatric Hand Surgery." British Journal of Plastic Surgery 47 |1994):324-330. -. "The Psychological Impact of Microvascular Free Toe Transfer for Children and Their Parents." The Journal of Hand Surgery 19B, no. 6 (December 1994):689-695. Braren, Victor, JohnJ. Warner, Ian M. Burr, Alfred Slonim, James A. O'Neill Jr., and Robert K. Rhamy. "True Hermaphroditism: A Rational Approach to Diagnosis and Treatment." Urology 15 (June 1980):569~ 574. Bullough, Vera. Sexual Variance in Society and History. New York: John Wiley and Sons, 1976. Burr, Chandler. "Homosexuality and Biology." The Atlantic Monthly (March 1993):47-65. Butler, Judith. Gender Trouble: Feminism and the Subversion of Identity. New York: Routledge, 1990. Cairns, Kathleen V., and Mary Valentich. "Vaginal Reconstruction in Gynecologic Cancer: A Feminist Perspective." The Journal of Sex Research 22, no. 3 (August 1986):333-346. Castro-Magana, Mariano, Moris Angulo, and Platon J. Collipp. "Management of the Child with Ambiguous Genitalia." Medical Aspects of Human Sexuality 18, no. 4 (April 1984):172-188. Chase, Cheryl. "Affronting Reason." In Looking Queer: Image and Identity in Lesbian, Bisexual, Gay, and Transgendered Communities, edited by D. Atkins. Binghamton, N.Y.: Haworth, forthcoming. ---------. "'Corrective' Surgery Unnecessary: Reply to 'Is It a Boy or a Girl?'" Johns Hopkins Magazine 46, no. 1 (February 1994):6-7. "Letter to the Editor Re: Measurement Of Pudendal Evoked Po- tentials During Feminizing Genitoplasty: Technique and Applications." The Journal of Urology 156, no. 3 (1995):1139. Chavis, William, John J. LaFerla, and Robert Niccolini. "Plastic Repair of Elongated, Hypertrophic Labia Minora." The Journal of Reproductive Medicine 34, no. 5 (1989):373-375. Clark, C. I., and S. Snooks. "Objectives of Basic Surgical Training." British Journal of Hospital Medicine 50 (1993):477^79. Collins, Patricia Hill. Black Feminist Thought: Knowledge, Consciousness, and the Politics of Empowerment. New York: Routledge, 1991. Corney, R. H., H. Everett, A. Howells, and M. E. Crowther. "Psychosocial Adjustment Following Major Gynaecological Surgery for Carcinoma of the Cervix and Vulva." Journal of Psychosomatic Research 36, no. 6(1992):561-568. Cowley, Geoffrey. "Gender Limbo." Newsweek, 19 May 1997, 64-66. Crooks, Robert, and Karla Baur. Our Sexuality. 6th ed. Pacific Grove, Calif.: Brooks/Cole Publishing, 1996. 170 Bibliography 171 Cruikshank, Stephen H. "Reconstructive procedures for the gynecologic surgeon." American Journal of Obstetrics and Gynecology 168 no 2 (February 1993):469^t75. De Jong, Tom P.V.M., and Thomas M. L. Boemers. "Neonatal Management of Female Intersex by Clitorovaginoplasty." The Journal Of IJrnlnvy 1.54 lAugust 19951:830-832. _____.______________ Devor, Holfy. "Female Gender Dysphoria in Context: Social Problems or Personal Problems." Annua] Review of Sex Research 7 (1996):44-89. ---------. FTM: Female-to-Male Transsexuals in Society. Bloomington: Indiana University Press, 1997. ---------. Gender Blending: Confronting the Limits of Duality. Bloomington: Indiana University Press, 1989. Dewhurst, J., and D. B. Grant. "Intersex Problems." Archives of Disease in Childhood 59 (July-December 1984):1191-1194. Diamond, Jared. "Turning A Man." Discover 13, no. 6 (June 1992):71-77. Diamond, Milton. "Human Sexual Development: Biological Foundations for Social Development." In Human Sexuality in Four Perspectives, edited by Frank A. Beach, 22-61. Baltimore: The Johns Hopkins University Press, 1976. ---------. "Sexual Identity, Monozygotic Twins Reared in Discordant Sex Roles and a BBC Follow-Up." Archives of Sexual Behavior 11, no. 2 (1982):181-186. --------, and Keith Sigmundson. "Sex Reassignment at Birth: Long-term Review and Clinical Applications." Archives of Pediatric and Adolescent Medicine 151 (May 1997):298-304. Donahoe, P. "Clinical Management of Intersex Abnormalities." Current Problems in Surgery 28 (1991):519-579. Dorland's Illustrated Medical Dictionary. 28th ed. Philadelphia: W. B. Saunders, 1997. Dreger, Alice Domurat. "Hermaphrodites in Love: The Truth of the Gonads." In Science and Homosexualities, edited by Vernon Rosario, 46-66. New York: Routledge, 1996. ---------. Hermaphrodites and the Medical Invention of Sex. Cambridge: Harvard University Press, 1998. Duckett, John W., and Laurence S. Baskin. "Genitoplasty for Intersex Anomalies." European Journal of Pediatrics 152 (1993):80~84. Dull, Diana, and Candace West. "Accounting for Cosmetic Surgery: The Accomplishment of Gender." Social Problems 38, no. 1 (February 1991):54-70. Ellis, Havelock. The Psychology of Sex. Garden City, N. J.: Garden City Books, 1933. ---------. Studies in the Psychology of Sex. New York: Random House, 1942. Epstein, Julia. "Either/Or—Neither/Both: Sexual Ambiguity and the Ideology of Gender." Genders 7 (spring 1990):99-142. Exner, M. J. The Sexual Side of Marriage. New York: W. W. Norton and Co., 1932. Fausto-Sterling, Anne. Body-Building: How Biologists Construct Sexuality. New York: HarperCollins, forthcoming. ---------. "The Five Sexes." The Sciences (March/April 1993):20-24. 172 Bibliography ---------. "Gender, Race, and Nation: The Comparative Anatomy of 'Hottentot' Women in Europe, 1815-1817." In Deviant Bodies: Critical Perspectives on Difference in Science and Popular Culture, edited by Jennifer Terry and Jacqueline Urla, 19-48. Bloomington: Indiana University Press, 1995. =--------; "How Many Sexes Are There?" Nsw York Times, 12 March 1993 Feder, Ellen K. "Disciplining the Family: The Case of Gender Identity Disorder." Philosophical Studies 85 (1997):195-211. Feldman, Kenneth W., and David W. Smith. "Fetal Phallic Growth and Penile Standards for Newborn Male Infants." The Journal of Pediatrics 86, no. 3 (March 1975):395^98. Fichtner, Jan, D. Filipas, A. M. Mottrie, G. E, Voges, and R. Hohenfellner. "Analysis of Meatal Location in 500 Men: Wide Variation Questions Need for Meatal Advancement in All Pediatric Anterior Hypospadias Cases." The journal of Urology 154 (August 1995):833-834. Fiedler, Leslie. Freaks: Myths and Images of the Second Self. New York: Simon and Schuster, 1978. Filardo, Thomas W. "Use of 'Normal' to Describe Penile Appearance after Circumcision." American Family Physician 53, no. 8 (June 1996):2440. Findlay, Deborah. "Discovering Sex: Medical Science, Feminism, and In-tersexuality." The Canadian Review of Sociology and Anthropology 32 (February 1995}:25-52. Flateau, E. "Penile size in the newborn infant." Letter to the Editor, The Journal of Pediatrics 87, no. 4 (October 1995):663-664. Forel, August, and C. F. Marshall. The Sexual Question. Brooklyn, N.Y.: Physicians & Surgeons Book Co., 1906. Foucault, Michel. Herculine Barbin. New York: Pantheon Books, 1978. ---------. History of Sexuality. New York: Pantheon Books, 1980. Freud, Sigmund. "Some Psychical Consequences of the Anatomical Distinctions between the Sexes" (1925). In The Complete Psychological Works, translated and edited by J. Strachy, vol. 18. New York: Norton, 1976. Frey, P., and A. Bianchi. "One-Stage Preputial Pedicle Flap Repair for Hypospadias: Experience with 100 Patients." Progress in Pediatric Surgery 23 (1989):181-191. Garber, Marjorie. "Spare Parts: The Surgical Construction of Gender." Differences: A Journal of Feminist Cultural Studies 1, no. 3 (fall 1989):137-159. Garfinkel, Harold. Studies in Ethnomethodology. Englewood Cliffs, N.J.: Prentice Hall, 1967. Garriques, Henry J. A Textbook of the Diseases of Women. Philadelphia: W B. Saunders. 1894. Gearhart, John P., Arthur Burnett, and Jeffrey H. Owen. "Measurement of Pudendal Evoked Potentials During Feminizing Genitoplasty: Technique and Applications." The Journal of Urology 153 (February 1995):486^87. ---------. "Reply by Authors Re: Measurement of Pudendal Evoked Poten- Bibfiography 173 tials During Feminizing Genitoplasty: Technique and Applications." The Journal of Urology 156, no. 3 (1995): 1140. Glassberg, Kenneth I. "Gender Assignment in Newborn Male Pseudohermaphrodites." Urologie Clinics of North America 7 (June 1980):409-421. ■„■■GoffmarL-Erving..^Stigma: Notes an the.Management, of SpniledJdentity. _ Englewood Cliffs, N.J.: Prentice Hall, 1963. Gooren, Louis, and Peggy T. Cohen-Kettenis. "Development of Male Gender Identity/Role and a Sexual Orientation Towards Women in a 46,XY Subject with an Incomplete Form of the Androgen Insensitiv-ity Syndrome." Archives of Sexual Behavior 20, no. 5 (199I):459-470. Green, James. "Getting Real about FTM Surgery." Chrysalis: The Journal of Transgressive Gender Identities 2, no. 2 (1995):27-32. Greenfield, Saul P., Barry T. Sadler, and Julian Wan. "Two-Stage Repair for Severe Hypospadias." The Journal of Urology 152 (August 1994):498-501. Gross, Robert E., Judson Randolph, and John F. Crigler Jr. "Clitorectomy for sexual abnormalities: Indications and technique." Surgery 59 (February 1966):300-308. Guthrie, Robert D., David W. Smith, and C. Benjamin Graham. "Testosterone treatment for micropenis during early childhood." The Journal of Pediatrics 83, no. 2 (1973):247-252. Hall, Winfield Scott. Sexual Knowledge. Philadelphia: The John C. Winston Co., 1916. Hatch, Kenneth D. "Neovaginal Reconstruction." CANCER supplement 71, no. 4 (February 1993): 1660-1663. Hausman, Bernice L. Changing Sex: Transsexualism, Technology, and the Idea of Gender. Durham and London: Duke University Press, 1995. Hecker, W. Ch. "Operative Correction of Intersexual Genitals in Children." Progressin Pediatric Surgery 17 (1984):21-31. Hendren, W. Hardy, and Anthony Atala. "Repair of High Vagina in Girls With Severely Masculinized Anatomy From the Adrenogenital Syndrome." Journal of Pediatric Surgery 30, no. 1 (January 1995):91-94. Hendricks, Melissa. "Is It a Boy or a Girl?" Johns Hopkins Magazine 45, no. 5 (November 1993):10-16. Hermaphrodites with Attitude. Newsletter of the Intersex Society of North America. San Francisco. Hinman, Frank Jr. "Microphallus: Characteristics and Choice of Treatment from a Study of 20 Cases." The Journal of Urology 107 (March I972}:499-505. Holmes, Morgan. "Homophobia in Health Care: Abjection and the Treatment of Intersexuality." Paper presented at the Learned Societies CSAA meetings, Montreal, June 1995. ---------. "Re-membering a Queer Body." Undercurrents (May 1994): 11-14. Holzaepfel, John H. Marriage Manual. Pamphlet distributed to physicians by Holland-Rantos Company, Inc. 1959. 174 Bibliography Horowitz, Sarah. "The Middle Sex." SF Weekly 13, no. 5 (1 February 1995):11-12. Hrdy, Sarah. The Woman that Never Evolved. Cambridge, Mass.: Harvard University Press, 1981. Hubbard, Ruth, and Elijah Wald. Exploding the Gene Myth. Boston: Beacon Press 1993. ____________■ ___ Huffman, John W. "Some Facts about the Clitoris." Post Graduate Medicine 60, no. 5 (November 1976):245-247. Irvine, Janice. Disorders of Desire: Sex and Gender in Modern American Sexology. Philadelphia: Temple University Press, 1990. "Is Early Vaginal Reconstruction Wrong for Some Intersex Girls?" Urology Times (February 1997):10~12. Jones, Howard W., and William Wallace Scott. Hermaphroditism, Genital Anomalies, and Related Endocrine Disorders. Baltimore: The Williams & Wilkins Co., 1958. Kaplan, Morris. Sexual Justice. New York: Routledge, 1997. Kessler, Suzanne J. "Creating Good-Looking Genitals in the Service of Gender." In A Queer World: The Center for Lesbian and Gay Studies Reader, edited by Martin Duberman, 153-173. New York: New York University Press, 1997. ---------. "Meanings of Genital Variability." Chrysalis: The Journal of Trans- gressive Gender Identities 1, no. 4 (fall 1997/winter 1998):33~38. ---------. Letter in response to Anne Fausto-Sterling's "The Five Sexes." The Sciences (July/August 1993):3. ---------, and Wendy McKenna. Gender: An Ethnomethodological Approach. New York: Wiley-Interscience, 1978; Chicago: University of Chicago Press, 1985. Kirk, Sheila. "It's Time For Your Medicine: Signs & Treatment For Inter-sexuality." Tapestry Journal 71 (spring 1995):11-13. Kogan, Stanley }., Paul Smey, and Selwyn B. Levitt. "Reply by Authors." The Journal of Urology 130 (October 1983):748. ---------. "Subtunical Total Reduction Chloroplasty: A Safe Modification of Existing Techniques." The Journal of Urology 130 (October 1983):746-748. Koyanagi, Tomohiko, Katsuya Nonomura, Tetsufumi Yamashita, Kouishi Kanagawa, and Hidehiro Kakizaki. "One-Stage Repair of Hypospadias: Is There No Simple Method Universally Applicable to All Types of Hypospadias?" Thejournalof Urology 152(October 1994): 1232-1237. Kremer, J., and H. P. den Daas. "Case Report: A Man with Breast Dysphoria." Archives of Sexual Behavior 19, no. 2 (1990):179-181. Kuhnle, Ursula, Monika Bullinger, and H. P. Schwarz. "The Quality of Life in Adult Female Patients with Congenital Adrenal Hyperplasia: A comprehensive study of the impact of genital malformations and chronic disease on female patients' life." European Journal of Pediatrics 154(1995):708-716. Kumar, H., J. H. Kiefer, I. E. Rosenthal, and S. S. Clark. "Clitoroplasty: Experience During a 19-Year Period." The Journal of Urology 111, no. 1 (January 1974):81-84. Lattimer, John K. "Editorial Comment on Stanley Kogan, et al's 'Subtunical Bibliography 175 Total Reduction Clitoroplasty: A Safe Modification of Existing Techniques.'" The Journal of Urology 130 (October 1983):748. ---------. "Relocation and Recession of the Enlarged Clitoris with Preservation of the Glans: An Alternative to Amputation." The Journal of Urology 81, no. 1 (1961): 113-116. Lee. F.llp.n Hyun-Iu. "Producing Sex: An Interdisciplinary Perspective on Sex Assignment Decisions for Intersexuals." Unpublished senior thesis, Brown University, April 1994. Lee, Peter A., Thomas Mazur, Robert Danish, James Amrhein, Robert M. Blizzard, John Money, and Claude J. Migeon. "Micropenis: I. Criteria, Etiologies and Classification." The Johns Hopkins Medical Journal 146 (1980):156-163. LeFiblec, Bernard. Author's reply to "Termination of XX Male Fetus." The Lancet 343 (7 May 1994):1165. Lev-Ran, Arye. "Sex Reversal as Related to Clinical Syndromes in Human Beings." In Handbook of Sexology II: Genetics, Hormones and Behavior, edited by John Money and H. Musaph, 157-173. New York: Elsevier, 1978. Lief, Harold I., and Lynn Hubschmann, "Orgasm in the Postoperative Transsexual." Archives of Sexual Behavior 22, no. 2 (1993):145-155. Lindemalm, Cunnar, Dag Korlin, and Nils Uddenberg. "Long-term Fol-low-Up of 'Sex Change' in 13 Male-to-Female Transsexuals." Archives of Sexual Behavior 15, no. 3 (1996):187-209. Lobe, Thorn E., Diane L. Woodall, Gail E. Richards, Anita Cavallo, and Walter J. Meyer. "The Complications of Surgery For Changing Patterns Over Two Decades." Journal of Pediatric Surgery 22, no. 7 (July 1987):651~652. Majeski, Tom. "Surgery Changes Russian Child's Sex." San Jose Mercury News, 25 July 1994. Martin, June. "The Incidence, Frequency and Rate of Genital Satisfaction of Sixty-Four Post-Operative Male-to-Female Transsexuals Reported to be Experienced During Various Sexual Behaviors: A Descriptive Study." Ph.D. dissertation. Institute for Advanced Study of Human Sexuality, San Francisco, 1988. Martinez-Mora, J., R. Isnard, A. Castellvi, and P. Lopez Ortiz. "Neovagina in Vaginal Agenesis: Surgical Methods and Long-Term Results." Journal of Pediatric Surgery 27, no. 1 (January 1992):10-14. Mazur, Tom. "Ambiguous Genitalia: Detection and Counseling." Pediatric Nursing 9 (November/December 1983):417-431. McGillivray, Barbara C. "The Newborn with Ambiguous Genitalia." Seminars in Perinatology 16, no. 6 (1992):365-368. McKenna, Wendy, and Suzanne Kessler. "Who Needs Gender Theory?" Signs: Journal of Women in Culture and Society (spring 1997):687- 691. Meyer-Bahlburg, Heino F. L. "Gender Assignment from the Clinician's Perspective." Paper presented at the annual meeting of The Society for the Scientific Study of Sex, San Francisco, November 1995. Mininberg, David T. "Phalloplasty in Congenital Adrenal Hyperplasia." The Journal of Urology 128 (August 1982):355-356. 176 Bibliography Money, John. "Birth Defect of the Sex Organs: Telling the Parents and the Patient." British journal of Sexual Medicine 10 (March 1983}:14. ---------. "Hermaphroditism and Pseudohermaphroditism." In Gynecologic Endocrinology, edited by Jay J. Gold, 449-4-64. New York: Hoeber 1968. ——. "Psychologic- Consideration of Sex Assignment in Tnre.rseviialiťv " Clinics in Plastic Surgery 1 (April 1974|:215-222.! ---------. "Psychological Counseling: Hermaphroditism." In Endocrine and Genetic Diseases of Childhood and Adolescence, edited by L. I. Gardner, 609-618. Philadelphia: W. B. Saunders, 1975. ---------. Sex Errors of the Body: Dilemmas, Education, Counseling. Baltimore: The Johns Hopkins University Press, 1968. Reprint, 1994. ---------, and Anke A. Ehrhardt. Man é) Woman, Boy &) Girl. Baltimore: The Johns Hopkins University Press, 1972. ---------, J. G. Hampson, and J. L. Hampson. "Hermaphroditism: Recommendations Concerning Assignment of Sex, Change of Sex, and Psychologic Management." Bulletin of the Johns Hopkins Hospital 97 (1955):284-300. ---------, Gregory K. Lehne, and Frantz Pierre-Jerome. "Micropenis: Adult FoIlow-Up and Comparison of Size against New Norms." Journal of Sex &) Marital Therapy 10, no. 2 {1984}: 105-114. ---------, Tom Mazur, Charles Abrams, and Bernard F. Norman, "Micropenis, Family Mental Health, and Neonatal Management: A Report on Fourteen Patients Reared as Girls." Journal of Preventive Psychiatry 1, no. 1 (1981}:17-27. ---------, Reynolds Potter, and Clarice S. Stoll. "Sex Reannouncement in Hereditary Sex Deformity: Psychology and Sociology of Habilitation." Social Science and Medicine 3 (1969]:207~216. ---------, M. Schwartz, and V. G. Lewis. "Adult Erotosexual Status and Fetal Hormonal Masculinization and Demasculinization: 46, XX Congenital Virilizing Adrenal Hyperplasia and 46, XY Androgen-insensitivity Syndrome Compared," Psychoneuroendocrinology 9 (1984):405-414. ---------, and Patricia Tucker. Sexual Signatures: On Being a Man or a Woman. Boston: Little Brown and Co., 1975. Morgan, Kathryn Pauly. "Women and the Knife: Cosmetic Surgery and the Colonization of Women's Bodies." Hypatia 6, no. 3 (fall 1991 ):25-53. Mulaikai, Rose M., Claude J. Migeon, and John A. Rock. "Fertility Rates in Female Patients with Congenital Adrenal Hyperplasia Due to 21-Hydroxylase Deficiency." The New England Journal of Medicine 316, no. 4 {22 January 1987):178-182. Mureau, Mark A. M., Froukje M. E. Slijper, A. Koos Slob, and Frank C. Verhulst. "Genital Perception of Children, Adolescents and Adults Operated on for Hypospadias: A Comparative Study," The Journal of Sex Research 32, no. 4 {winter 1995);289-298. Napheys, Geo. H. The Physical Life of Women: Advice to the Maiden, Wife and Mother. Philadelphia: George Maclean, 1870. Newman, Kurt, Judson Randolph, and Kathryn Anderson. "The Surgical Bibliography 177 Management of Infants and Children With Ambiguous Genitalia." Ann. Surg. 215, no. 6 (June 1992):644-653. Oberfeld, Sharon E., Aurora Mondok, Farrokh Shahrivar, Janice F. Klein, and Lenore S. Levine. "Clitoral Size in Full-Term Infants." American Journal of Perinatology 6, no. 4 (October 1989):453-454. Qesterling-ioseph E,. John P. Gearhart, and Robert D. Jeffs. "A Unified Approach to Early Reconstructive Surgery of the Child With Ambiguous Genitalia." The Journal of Urology 138 (October 1987):1079-1084. Oliven, John F. Sexual Hygiene and Pathology: A Manual for the Physician. Philadelphia: J. B. Lippincott Co., 1955. Ortner, Sherry B. "Is Female to Male as Nature is to Culture?" In Woman, Culture, and Society, edited by Michelle Zimbalist Rosaldo and Louise Lamphere, 67-87. Stanford, Calif.: Stanford University Press, 1974. Patil, U., and F. P. Hixson. "The Role of Tissue Expanders in Vaginoplasty for Congenital Malformations of the Vagina." British Journal of Urol-ogy 70 {1992):554-557. Perlmutter, Alan, and Claude Reitelman. "Surgical Management of Inter-sexuality." In Campbell's Urology, edited by Patrick Walsh, 1951-1966. Philadelphia: W. B. Saunders, 1992. Perovic, Sara, "Male to Female Surgery: A New Contribution to Operative Techniques." Plastic and Reconstructive Surgery 91, no. 4 (April 1993}:704-710. ---------. "Phalloplasty in Children and Adolescents Using the Extended Pedicle Island Groin Flap." The Journal of Urology 154 (August 1995):848-853. Pinter, A., and G. Kosztolanyi. "Surgical Management of Neonates and Children with Ambiguous Genitalia." University Children's Hospital of Pecs /Hungary 30, no. 1 (1990):111-121. Quattrin, Theresa, Susan Aronica, and Tom Mazur. "Management of Male Pseudohermaphroditism: A Case Report Spanning Twenty-One Years." Journal of Pediatric Psychology 15, no. 6 (1990}:699-709. Quigley, Charmian, and Frank French. "Androgen Receptor Defects: Historical, Clinical and Molecular Perspectives." Endocrine Reviews 16, no.3(1995):271~321. Radman, Melvin H. "Hypertrophy of the Labia Minora." Obstetrics and Gynecology 48, no. 1 (July 1976):78-80. Randolph, Judson, and Wellington Hung. "Reduction Clitoroplasty in Females with Hypertrophied Clitoris." Journal of Pediatric Surgery 5, no. 2(Aprill970):224-231. Randolph, Judson, Wellington Hung, and Mary Colaianni Rathlev. "Clitoroplasty for Females Born with Ambiguous Genitalia: A Long-Term Study of 37 patients." Journal of Pediatric Surgery 16, no. 6 (December 1981):882-887. "ReadMyLips." Tasteof Latex{9 November 1993):7. Reilly, Justine M., and C.R.J. Woodhouse, "Small Penis and the Male Sexual Role." The Journal of Urology 142 (August 1989):569-571. 178 Bibliography Renshaw, Domeena C. "Sexual Birth Defects: Telling The Parents." Resident Staff Physician 39, no. 2 (February 1993):87-89. Rogan, Helen. "A Woman's Mag Masks Sleaze as Service." Ms. (September-October 1994):92-93. Rohatgi, M. "intersex Disorders: An Approach to Surgical Management." Indian Journal of PeAintrirx SQ {1 qp7l-M.3-SAn .________________ Roslyn, JoelJ., Eric W. Fonkalsrud, and Barbara Lippe, "intersex Disorders in Adolescents and Adults." The American Journal of Surgery 146 (July 1983): 138-144. Rothblatt, Martine. "Gender Manifesto." Tapestry Journal 71 (spring 1995(:31-36. Rubin, Jeffrey, F. J. Provenzano, and Z. Luria. "The Eye of the Beholder: Parents' Views on Sex of Newborns." American Journal of Orthopsychiatry 44, no. 4 (1974|:512-519. Ruminjo, J. "Circumcision in Women." East African Medical Journal (September 1992):477-478. Sane, Kumud, and Ora Hirsch Pescovitz. "The Clitoral Index: A determination of clitoral size in normal girls and in girls with abnormal sexual development." The Journal of Pediatrics 120 (2 Pt 1) (February 1992):264-266. Schlüssel, Richard. Lecture at Update in Pediatric Plastic and Reconstructive Surgery, a symposium at Mount Sinai Medical Center, New York, 17 May 1996. Schober, Justine M. "Long-Term Outcomes of Feminizing Genitoplasty For Intersex." In Pediatric Surgery and Urology: Longterm Outcomes, edited by Pierre Mouriquant. London: W. B. Saunders, forthcoming. Schonfeld, William A., and Gilbert W. Beebe. "Normal Growth and Variation in the Male Genitalia from Birth to Maturity." The Journal of Urology48 (1942):759-777. Schover, L. W., and M. Fife. "Sexual Counseling of Patients Undergoing Radical Surgery for Pelvic or Genital Cancer." Journal of Psychosocial Oncology 3 |1986):21-41. Schultz, W.C.M. Weijmar, K. Wijma, H.B.M. Van de Wiel, J. Bouma, and J. Janssens. "Sexual Rehabilitation of Radical Vulvectomy Patients. A Pilot Study." Journal of Psychosomatic Obstetrics and Gynecology 5(1986):119-126. Slijper, F.M.E., H. J. van der Kamp, H. Branbenburg, S.M.P.F. de Muinck Keizer-Schrama, S.L.S. Drop, and J. C. Molenaar. "Evaluation of Psy-chosexual Development of Young Women with Congenital Adrenal Hyperplasia: A Pilot Study." Journal of Sex Education and Therapy 18, no. 2(1992}:200-207. Slijper, F.M.E., S.L.S. Drop, J. C. Molenaar, and R. J. Scholtmeijer. "Neonates with Abnormal Genital Development Assigned the Female Sex: Parent Counseling." Journal of Sex Education and Therapy 20, no. 1 (1994):9-17. Smith, Richard W. "What kind of sex is natural?" In The Frontiers of Sex Research, edited by Vern Bullough, 103-111. Buffalo: Prometheus, 1979. Smyth, Cherry. "How Shall I Address You? On Our Backs (Jan./Feb. 1995|:19-23. Bibliography 179 Sotiropoulos, A., A. Morishima, Y. Homsy, and J. K. Lattimer. "Long-Term Assessment of Genital Reconstruction in Female Pseudohermaphrodites." The Journal of Urology 115 (May 1976):599-601. Stecker, John F. Jr., Charles E. Horton, Charles J. Devine Jr., and John B. McCraw. "Hypospadias Cripples." Symposium on Hyspospadias. ......Uroloeic Clinics of North America 8, no. 3 (October 1981):539-544. Stock, Jeffrey A., Jose Cortez, Hal C. Scherz, and George W. KapläüT;,'The " Management of Proximal Hypospadias Using a 1-Stage Hypospadias Repair with a Preputial Free Graft For Neourethral Construction and a Preputial Pedicle Flap for Ventral Skin Coverage." The Journal of Urology 152 (December 1994):2335-2337. Stoll, Clarice Stasz, ed. Sexism: Scientific Debates. Reading, Mass.: Addison-Wesley Publishing Company, 1973. Stoller, Robert J. Sex and Gender. Vol. 1. New York: J. Aronson, 1968. Teague, J. L., D. R. Roth, and E. T. Gonzales. "Repair of Hypospadias Complications Using the Meatal Based Flap Urethroplasty." The Journal of Urology 151 (February 1994):470-472. Tiefer, Leonore. "The Medicalization of Impotence—Normalizing Phallo-centrism." Gender &? Society 8, no. 3 (September 1994):363-377. ---------. "Might Premature Ejaculation Be Organic? The Perfect Penis Takes a Giant Step Forward." Journal of Sex Education and Therapy 20, no. 1 (1994):7-8. Toby. Finding Our Own Ways. Self-published newsletter. 1987. Tong, Steven Y. C, Karen Donaldson, and John M. Hutson. "When Is Hypospadias Not Hypospadias?" MJA 164 (5 February 1996):153-154. Van Seters, A. P., and A. K. Slob. "Mutually Gratifying Heterosexual Relationship with Micropenis of Husband." Journal of Sex